Provider Demographics
NPI:1790754406
Name:ARKANSAS NEUROPSYCHOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:ARKANSAS NEUROPSYCHOLOGY ASSOCIATES
Other - Org Name:AN ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPECK-KERN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:501-664-1050
Mailing Address - Street 1:3 INNWOOD CR., STE 111
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211
Mailing Address - Country:US
Mailing Address - Phone:501-664-1050
Mailing Address - Fax:888-684-7266
Practice Address - Street 1:3 INNWOOD CIRCLE
Practice Address - Street 2:STE 111
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211
Practice Address - Country:US
Practice Address - Phone:501-664-1050
Practice Address - Fax:888-684-7266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR103G00000X, 103T00000X
AR86-21P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117585719Medicaid
AR59317OtherAR BLUE CROSS BLUE SHIELD